CT health system, major insurer at odds over new contract. What it could mean for patients.

Farmington-based UConn Health is warning thousands of patients with Aetna insurance coverage that they may lose their “in-network” status with the health system’s hospital, clinics and doctors if both sides can’t reach an agreement on a new contract.

The negotiations between UConn Health — the parent of John Dempsey Hospital, a network of clinics and more than 700 providers —  and Hartford-based Aetna, the health insurance giant owned by CVS Health Corp., remain at odds over reimbursement rates for services.

UConn Health was locked in a similar dispute with health insurer Farmington-based ConnectiCare earlier this year.

UConn Health said 15,000 patients would be affected by the outcome of the contract negotiations with Aetna. The contract expires Nov. 30.

Depending on the Aetna policy, there may be a 60-day grace period after the contract’s expiration in which patients remain in network and both UConn Health and Aetna could still try to hammer out a new contract, according to the health system.

On Nov. 10, UConn Health will start informing patients with appointments about the potential change in ‘in network’ status that could begin Dec. 1.

UConn argues its reimbursement rate is “much lower” than the rates of other hospitals in Connecticut, despite revenue growth in the last decade and rankings that place it in the top tier of hospitals nationwide.

In a statement on its website, UConn Health said the two sides are negotiating, but “Aetna has not yet offered fair rates for our services.”

“As a Hartford-based company with a national footprint, Aetna has both the scale and local responsibility to be a fair partner. one that recognizes the value of the care UConn Health provides to families,” according, in part, to the online statement. “Their refusal to address this unfair gap is putting patients at risk of losing in-network access to UConn Health…”

Aetna says it is committed to reaching a fair agreement that keeps UConn Health in its network at an affordable rate.

“However, Aetna cannot agree to annual rate increases that are multiple times higher than the Connecticut cost growth benchmark, as this would drive up health plan costs for our members and local employers,” CVS spokeswoman Shelly F. Bendit said, in a statement. “As our discussions continue, we hope to come to terms with UConn Health on a reasonable rate increase that keeps healthcare costs affordable.”

Bendit said, “If we do not reach an agreement by December 1, UConn Health facilities and doctors will no longer be part of the network for most Aetna Commercial members and all Aetna Medicare members.”

State of Connecticut retirees with Aetna Medicare PPO Extended Service Area patients would be excluded from termination. An ESA is a plan that allows members to see out-of-network providers.

In addition, there can be exceptions for “continuing care” such as chemotherapy treatments that remain in-network even in the absence of a contract.

According to healthinsurance.org, depending on the health plan “expenses incurred for services provided by out-of-network health professionals may not be covered at all unless it’s an emergency. Or they may be covered but with higher out-of-pocket costs than the member would pay for same care received from an in-network provider.”

In addition, “the federal cap on out-of-pocket costs only applies to in-network care (and only care that’s considered an essential health benefit). So out-of-pocket costs for covered out-of-network care can be much higher, or even unlimited. And, it’s important to understand that out-of-network providers can and do balance bill patients for the remainder of the charges after the insurance company has paid its share.”

Consumers who find themselves out-of-network may be forced to find new health care providers that are in-network.

UConn Health — an arm of the University of Connecticut — is starting to play hardball in contract negotiations with insurers.

Earlier this year, the health system took out billboards along I-84 and I-91 pressuring another health insurer, Farmington-based ConnectiCare, to increase its reimbursement rates for medical services. ConnectiCare was acquired by California-based Molina Healthcare in February.

UConn Health subsequently negotiated a new agreement with ConnectiCare after the current contract had expired.

Kenneth R. Gosselin can be reached at [email protected].

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